The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02336841.

Psychometric properties of the Italian version of the Experience in Close Relationship Scale 12 (ECR-12): an exploratory structural equation modeling study

The Experiences in Close Relationship Scale (ECR) is one of the most commonly used self-report instruments of adult attachment and has been widely adopted in psychotherapy research. Composed of two subscales, namely Attachment Avoidance and Anxiety, the ECR was recently shortened to a 12-items version, called the ECR-12. Given the importance of extending knowledge on its applicability in understudied populations, our aim was to validate the ECR-12 in a large sample of Italian native-speakers. A total of 1197 participants (73.2% females; mean age=28.53±11.37 years) completed the ECR-12. Each participant also completed other measures of attachment, psychopathology, interpersonal distress, coping strategies, and well-being. An Exploratory Structural Equation Modeling analysis showed an excellent fit of the data, providing support for the two-dimensional orthogonal structure of the ECR-12. In addition, the measurement model was invariant across genders. Both attachment anxiety and attachment avoidance subscales demonstrated good internal reliability, with McDonald’s Omegas and Cronbach’s Alphas above the suggested 0.8 cut-off. Finally, the Italian version of ECR-12 showed adequate convergent, concurrent, and divergent validity. Highly anxious individuals reported the highest levels of maladaptive interpersonal functioning and coping strategies, resulting in lower well-being. Interestingly, both attachment insecurity dimensions predicted higher levels of psychopathology, even after controlling for demographic variables and levels of self-reported relational difficulties. Given the good psychometric properties of the ECR-12, researchers and practitioners in Italy are encouraged to adopt the ECR-12 in their future research on adult attachment in psychotherapy.

Development and testing of a model for risk and protective factors for eating disorders and higher weight among emerging adults: A study protocol

Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18-30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors - both cross-sectionally and longitudinally - of both ED and higher weight, and how these vary across countries and gender.

Magic Mirror on the Wall: Selfie-Related Behavior as Mediator of the Relationship Between Narcissism and Problematic Smartphone Use

OBJECTIVE

Recent research has suggested that problematic smartphone use is associated with several psychological factors and that mobile apps and smartphone-related behavior (i.e. selfie behavior) may encourage the development of problematic smartphone use. However, little is known about how the interplay between dysfunctional personality characteristics and selfie-related behavior can influence problematic smartphone use. The aim of this study was to examine the relationship between narcissism and problematic smartphone use, as well as the mediating role of selfie-related behavior in this relationship among young men and women.

METHOD

In the current study, a total of 627 undergraduate students (283 males and 344 females) completed a cross-sectional survey. A structural equation model was tested separately for males and females in order to evaluate the associations between narcissism, selfie-related behavior and problematic smartphone use.

RESULTS

The results showed that greater narcissism was related to increased selfie-related behavior, which in turn were positively associated with problematic smartphone use both for males and females. However, selfie-related behavior mediated the relationship between narcissism and problematic smartphone use only for females.

CONCLUSIONS

The study provides fresh insight into our understanding of the psychological mechanisms underlying problematic smartphone use, which may inform prevention and treatment interventions.

Interpersonal difficulties in obesity: A systematic review and meta-analysis to inform a rejection sensitivity-based model

Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals' quality of life and behaviour change efforts. Increased sensitivity to others' negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.

The codevelopment of group relationships: The role of individual group member's and other group members' mutual influence and shared group environment

Although recent research has provided empirical support for the codevelopment of group interaction (defined as development in a common direction of perceptions of group relationships), no studies have yet investigated the "causes" of codevelopment among group members in the long term. The aim of the current study is to examine how the perceptions of an individual group member, and other group members, regarding group relationships influence each other over the course of treatment. We analyzed group data from 168 adult obese patients who participated in (1 of 20) 12-session therapy groups for weight management. Group relationships were measured by the Group Questionnaire (Krogel et al., 2013), which was administered to group members in early, middle and late group sessions. The longitudinal version of the group actor-partner interdependence model was used to analyze the influence among members. Results showed that there is no mutual influence in the codevelopment of both positive bonding and negative relationship. However, positive bonding of other group members in the middle of the group influenced positive bonding of the individual group member in the late group session. Moreover, individual group member negative relationships in early and middle sessions influenced other group member negative relationships in middle and late sessions. Finally, there was evidence of mutual influence in the codevelopment of positive working early in the group. The findings show that the process of influence among members is complex with regard to the specific dimension of the group relationship assessed and the time spent in group treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Task-sharing interventions for patients with anorexia nervosa or their carers: a systematic evaluation of the literature and meta-analysis of outcomes

The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing.

Ruptures and repairs of group therapy alliance. An untold story in psychotherapy research

Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context.

Problematic video game use as an emotional coping strategy: Evidence from a sample of MMORPG gamers

BACKGROUND

A positive relationship between problematic gaming and escapism motivation to play video games has been well established, suggesting that problematic gaming may result from attempts to deal with negative emotions. However, to date, no study has examined how emotion dysregulation affects both escapism motives and problematic gaming patterns.

METHODS

Difficulties in emotion regulation, escapism, and problematic involvement with video games were assessed in a sample of 390 World of Warcraft players. A structural equation modeling framework was used to test the hypothesis that escapism mediates the relationship between emotion dysregulation and problematic gaming.

RESULTS

Statistical analyses showed that difficulties in emotion regulation predicted both escapism motives and problematic gaming, and that escapism partially mediated this relationship.

CONCLUSION

Our findings support the view that problematic players are likely to escape in online games as a maladaptive coping strategy for dealing with adverse emotional experiences.

Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials

BACKGROUND AND AIMS

From residential programs to outpatient services, group therapy permeates the clinical field of substance misuse. While several group interventions for substance use disorders (SUDs) have demonstrated effectiveness, the existing evidence on group therapy has not been systematically reviewed. The current meta-analysis aims to provide estimates of the efficacy of group therapy for SUDs in adults using rigorous methods.

METHODS

We included studies comparing group psychotherapy to no treatment control groups, individual psychotherapy, medication, self-help groups, and other active treatments applying no specific psychotherapeutic techniques for patients with substance use disorder. The primary outcome was abstinence, and the secondary outcomes were frequency of substance use and symptoms of substance use disorder, anxiety, depression, general psychopathology, and attrition. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, and PsycINFO, complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups.

RESULTS

Thirty-three studies were included. Significant small effects of group therapy were found on abstinence compared to no treatment, individual therapy, and other treatments. Effects on substance use frequency and SUD symptoms were not significant, but significant moderately sized effects emerged for mental state when group therapy was compared to no treatment. There were no differences in abstinence rates between group therapy and control groups. These results were robust in sensitivity analyses and there was no indication of publication bias.

CONCLUSIONS

The current findings represent the best available summary analysis of group therapy for SUDs in adults, however cautious interpretation is warranted given the limitations of the available data.

Fear of Missing Out as a Predictor of Problematic Social Media Use and Phubbing Behavior among Flemish Adolescents

Fear-of-missing-out (FOMO) refers to feelings of anxiety that arise from the realization that you may be missing out on rewarding experiences that others are having. FOMO can be identified as an intra-personal trait that drives people to stay up to date of what other people are doing, among others on social media platforms. Drawing from the findings of a large-scale survey study among 2663 Flemish teenagers, this study explores the relationships between FOMO, social media use, problematic social media use (PSMU) and phubbing behavior. In line with our expectations, FOMO was a positive predictor of both how frequently teenagers use several social media platforms and of how many platforms they actively use. FOMO was a stronger predictor of the use of social media platforms that are more private (e.g., Facebook, Snapchat) than platforms that are more public in nature (e.g., Twitter, Youtube). FOMO predicted phubbing behavior both directly and indirectly via its relationship with PSMU. These findings support extant research that points towards FOMO as a factor explaining teenagers’ social media use.

Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study

BACKGROUND

Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex.

METHOD

A sample of 177 patients with BED (mean age: 41.0 ± 12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ± 13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ± 9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point.

RESULTS

Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership.

DISCUSSION

Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.

The Italian Version of the Inventory of Interpersonal Problems (IIP-32): Psychometric Properties and Factor Structure in Clinical and Non-clinical Groups

All versions of the Inventory of Interpersonal Problems (IIP) are broadly used to measure people's interpersonal functioning. The aims of the current study are: (a) to examine the psychometric properties and factor structure of the Italian version of the Inventory of Interpersonal Problems—short version (IIP-32); and (b) to evaluate its associations with core symptoms of different eating disorders. One thousand two hundred and twenty three participants (n = 623 non-clinical and n = 600 clinical participants with eating disorders and obesity) filled out the Inventory of Interpersonal Problems—short version (IIP-32) along with measures of self-esteem (Rosenberg Self-Esteem Scale, RSES), psychological functioning (Outcome Questionnaire, OQ-45), and eating disorders (Eating Disorder Inventory, EDI-3). The present study examined the eight-factor structure of the IIP-32 with Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM). ESEM was also used to test the measurement invariance of the IIP-32 across clinical and non-clinical groups. It was found that CFA had unsatisfactory model fit, whereas the corresponding ESEM solution provided a better fit to the observed data. However, six target factor loadings tend to be modest, and ten items showed cross-loadings higher than 0.30. The configural and metric invariance as well as the scalar and partial strict invariance of the IIP-32 were supported across clinical and non-clinical groups. The internal consistency of the IIP-32 was acceptable and the construct validity was confirmed by significant correlations between IIP-32, RSES, and OQ-45. Furthermore, overall interpersonal difficulties were consistently associated with core eating disorder symptoms, whereas interpersonal styles that reflect the inability to form close relationships, social awkwardness, the inability to be assertive, and a tendency to self-sacrificing were positively associated with general psychological maladjustment. Although further validation of the Italian version of the IIP-32 is needed to support these findings, the results on its cross-cultural validity are promising.

Type D Personality and Alexithymia: Common Characteristics of Two Different Constructs. Implications for Research and Clinical Practice

In the last few decades, particular attention has been paid to the role of personality specific traits that can affect the loss of health, i.e., Type D personality and Alexithymia. They have been conceptualized in a different period, this means that they are different both for their theoretical positions and their empirical studies. Some authors have speculated that there is a potential conceptual overlap between Type D personality and alexithymia constructs but there is a shortcoming in the literature. The aim of the study was to examine the potential overlap between the constructs of type D personality and alexithymia, replicating previous two studies, to extend these findings to Italian population. The participants were 247 Italian adults (males = 43%), recruited in primary health care practices of Palermo. All participants did not have chronic diseases during tests administration. They ranged in age from 35 to 69 years old (M = 52.34 years, SD = 9.76). Participants were administered Type D Personality Scale (DS-14) and Toronto Alexithymia Scale (TAS-20). A series of confirmatory factor analyses was performed to evaluate the factorial structure underlying the TAS-20 and DS-14 items. Globally results showed that alexithymia and type D personality are distinct constructs, but they are also strictly positively related with each other. Negative affectivity (NA) was highly correlated with Difficulties in identifying feelings and Difficulties in describing feelings, while Social inhibition (SI) was highly correlated with Difficulties in describing feelings. These results are consistent with those of other studies conducted in this area. Future research should consider evaluating the relationship between a deficit of affect regulation and type D personality to improve the effectiveness of interventions of health cure.

The Italian version of the Depressive Experiences Questionnaire: psychometric properties and validation in students, community, and clinical groups

The current study evaluated the psychometric properties of the Italian validation of the Depressive Experiences Questionnaire (DEQ), conceived as a measure of self-criticism and dependency, i.e. two personality factors acting, according to Blatt (2004), as risk factors for depression in particular and psychopathology in general. A series of standardized measures [Beck Depression Inventory-II (BDI-II), DEQ, Symptom Checklist-90-R (SCL-90-R), Millon Clinical Multiaxial Inventory, 3rd edition (MCMI-III)] was administered to three samples (i.e., students, community and clinical). Factorial validity was evaluated along with convergent and predictive validity. In order to evaluate the reliability and internal consistency, a specific subgroup of participants was retested on the DEQ and BDI-II. Results showed correlations between DEQ dimensions and some personality traits of the MCMI-III. The traditional three-factor model of the DEQ structure as identified by principal component analysis appears to be as stable factors as typically found in American samples, although some items showed elevated cross-loading or low loadings on any factor. Clinical and diagnostic implications of the findings will be discussed.

Attachment Anxiety and Attachment Avoidance: Members' Attachment Fit with Their Group and Group Relationships

We compared each individual group member's attachment fit with the attachment of the other group members. Participants were 201 members of 20 therapy groups who sought treatment because they were overweight or obese. Group members completed the Attachment Style Questionnaire before commencing treatment and the Group Questionnaire at three points during group treatment. Multilevel polynomial regression followed by response surface analysis was used to examine how the attachment anxiety and avoidance of the individual group member and the aggregated attachment anxiety and avoidance of the group members were related to individual group members' perceptions of the positive bonding, positive working relationships, and negative relationships in the group. The findings suggested that attachment heterogeneity in group is related to the perception of members' stronger bonding relationships and lower negative relationships. In addition, positive bonding can be increased when a patient high in attachment avoidance is added to a group whose patients are low in attachment avoidance; however, group members reported weaker negative relationships when their attachment anxiety or avoidance became increasingly higher or lower than other group members' attachment anxiety or avoidance.

Group relationships in early and late sessions and improvement in interpersonal problems

Groups are more effective when positive bonds are established and interpersonal conflicts resolved in early sessions and work is accomplished in later sessions. Previous research has provided mixed support for this group development model. We performed a test of this theoretical perspective using group members' (actors) and aggregated group members' (partners) perceptions of positive bonding, positive working, and negative group relationships measured early and late in interpersonal growth groups. Participants were 325 Italian graduate students randomly (within semester) assigned to 1 of 16 interpersonal growth groups. Groups met for 9 weeks with experienced psychologists using Yalom and Leszcz's (2005) interpersonal process model. Outcome was assessed pre- and posttreatment using the Inventory of Interpersonal Problems, and group relationships were measured at Sessions 3 and 6 using the Group Questionnaire. As hypothesized, early measures of positive bonding and late measures of positive working, for both actors and partners, were positively related to improved interpersonal problems. Also as hypothesized, late measures of positive bonding and early measures of positive working, for both actors and partners, were negatively related to improved interpersonal problems. We also found that early actor and partner positive bonding and negative relationships interacted to predict changes in interpersonal problems. The findings are consistent with group development theory and suggest that group therapists focus on group-as-a-whole positive bonding relationships in early group sessions and on group-as-a-whole positive working relationships in later group sessions. (PsycINFO Database Record

Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis

OBJECTIVE

Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept.

METHOD

The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect.

RESULTS

Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94-8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24-6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38-7.42) and AUC = .71.

CONCLUSION

Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

Infertility-related stress, anxiety and ovarian stimulation: can couples be reassured about the effects of psychological factors on biological responses to assisted reproductive technology?

The aim of this prospective, longitudinal study was to examine the association between couples' pre-treatment psychological characteristics (state anxiety and infertility-related stress levels of both partners) and ovarian response during assisted reproductive technology treatment in a well-controlled sample. A total of 217 heterosexual couples (434 patients), suffering from primary infertility and undergoing their first assisted reproductive technology treatment at the Reproductive Medicine Unit of ANDROS Day Surgery Clinic in Palermo (Italy), were recruited. Psychological variables were assessed using the State Scale of State-Trait Anxiety Inventory (STAI-S) and the Fertility Problem Inventory (FPI). The number of follicles ≥ 16 mm in diameter, evaluated by transvaginal ultrasound scan on the eleventh day of the workup, was chosen as the outcome measure. No association between women's level of anxiety and infertility-related stress, and the number of follicles ≥ 16 mm in diameter was found. Moreover, the male partner's infertility stress and anxiety did not influence the relationship between the woman's infertility-related stress, anxiety level and ovarian response. Fertility staff should reassure couples that the woman's biological response to ovarian stimulation is not influenced by either partner's level of psychological distress.

Assessing infertility-related stress: the factor structure of the Fertility Problem Inventory in Italian couples undergoing infertility treatment

The factor structure of the Fertility Problem Inventory (FPI) and its invariance across gender were examined in Italian couples undergoing infertility treatment. About 1000 subjects (both partners of 500 couples) completed two questionnaires prior to commencing infertility treatment at a private Clinic in Palermo, Italy. Confirmatory Factor Analysis demonstrated that the original factor structure of the FPI was partially confirmed. Two correlated factors (Infertility Life Domains and Importance of Parenthood) were obtained via a post hoc Exploratory Factor Analysis. Finally, the invariance of this factor structure across gender was confirmed. The study supported the relevance of two interrelated factors specific to infertility stress which could help clinicians to focus on the core infertility-related stress domains of infertile couples.

The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa

OBJECTIVE

The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa.

METHOD

A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report.

RESULTS

Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent.

DISCUSSION

The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours.

TRIAL REGISTRATION

ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Congruence of group therapist and group member alliance judgments in emotionally focused group therapy for binge eating disorder

We used West and Kenny's (2011) Truth-and-Bias (T&B) model to examine how accurately group therapists' judge their group members' alliances, and the effects of therapist-patient congruence in alliance ratings on patient outcomes. Were considered: (a) directional bias - therapists' tendency to over- or underrate their clients' alliances, (b) truth strength - clients' alliance ratings, and (c) bias strength - therapists' tendency to conflate their alliance ratings for a specific group member with the average alliance ratings for the other members of the group. There were 118 obese adult patients with binge-eating disorder that were treated by 8 therapists with Emotionally Focused Group Therapy. Outcomes were operationalized as pre- to postchanges in: health-related quality of life, binge eating, and psychological distress. Patients' and therapists' working alliance were assessed after the 2nd, 10th, and last (20th) group therapy sessions. (a) There was no significant congruence between group therapists' and members' ratings of alliance; (b) therapists' ratings of an individual group member's alliance were significantly related to therapists' ratings of the other group members' alliance in early sessions but unrelated in later sessions; and (c) the relationship between therapists' alliance ratings and bias strength was weaker when patient binge eating outcomes improved. Group therapists adopted a "better safe than sorry" strategy by underestimating the strength of their group members' alliances. Therapists had a tendency to judge each group member's individual alliance based on the aggregated alliance of the other group members. Improvement in patient binge eating outcomes was related to therapists overcoming this tendency. (PsycINFO Database Record

An examination of the impact of care giving styles (accommodation and skilful communication and support) on the one year outcome of adolescent anorexia nervosa: Testing the assumptions of the cognitive interpersonal model in anorexia nervosa

BACKGROUND

The cognitive interpersonal model predicts that parental caregiving style will impact on the rate of improvement of anorexia nervosa symptoms. The study aims to examine whether the absolute levels and the relative congruence between mothers' and fathers' care giving styles influenced the rate of change of their children's symptoms of anorexia nervosa over 12 months.

METHODS

Triads (n=54) consisting of patients with anorexia nervosa and both of their parents were included in the study. Caregivers completed the Caregiver Skills scale and the Accommodation and Enabling Scale at intake. Patients completed the Short Evaluation of Eating Disorders at intake and at monthly intervals for one year. Polynomial Hierarchical Linear Modeling was used for the analysis.

RESULTS

There is a person/dose dependant relationship between accommodation and patients' outcome, i.e. when both mother and father are highly accommodating outcome is poor, if either is highly accommodating outcome is intermediate and if both parents are low on accommodation outcome is good. Outcome is also good if both parents or mother alone have high levels of carer skills and poor if both have low levels of skills.

LIMITATIONS

Including only a sub-sample of an adolescent clinical population; not considering time spent care giving, and reporting patient's self-reported outcome data limits the generalisability of the current findings.

CONCLUSION

Accommodating and enabling behaviours by family members can serve to maintain eating disorder behaviours. However, skilful behaviours particularly by mothers, can aid recovery. Clinical interventions to optimise care giving skills and to reduce accommodation by both parents may be an important addition to treatment for anorexia nervosa.

Development and validation of a scale to measure caregiver skills in eating disorders

OBJECTIVE

The aim of this study was to develop and validate a new questionnaire designed to measure caregiver skills that, in line with the interpersonal component of the cognitive interpersonal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006), may be helpful in the support of people with anorexia nervosa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions.

METHOD

The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies of caregiver interventions (a clinical trial of the effectiveness of guided self-help and training workshops). Exploratory and confirmatory factor analyses (CFA) were used to test the factorial structure of the CASK scale. Cronbach's alpha was used to measure internal consistency of the CASK scales.

RESULTS

Exploratory Factor Analysis suggested a six component solution (Bigger Picture, Self-Care, Biting-Your-Tongue, Insight and Acceptance, Emotional Intelligence and Frustration Tolerance) and this model was confirmed with CFA. Significant clinically relevant correlations were found between the CASK scales and other standardised measures of caregivers' attitudes and behaviours. Furthermore, greater improvements on abilities measured by the CASK scale were found in caregivers who received skills-training than caregivers assigned to a 'treatment as usual' condition.

DISCUSSION

The CASK scale is a measure of the fidelity of interventions based on the cognitive interpersonal maintenance model and is sensitive to the intensity of the intervention provided.

Is there a group effect? It depends on how you ask the question: intraclass correlations for California Psychotherapy Alliance Scale-Group items

California Psychotherapy Alliance Scale-Group (CALPAS-G) data were collected from 1,138 group sessions attended by 248 group members in 16 counseling groups. Hierarchical linear modeling (HLM) was used to derive between-groups, between-member, and between-session variance components and intraclass correlation coefficients (ICCs) for the 12 CALPAS-G items. Using Ledermann and Kenny's (2012) descriptions of variable types, we examined differences in between-groups variance for the 6 CALPAS-G items classified as "Individual" items and the 6 CALPAS-G items classified as "Group" items. A Related-Samples Wilcoxon's Signed Ranked Test showed that the ICCs for the Group items were significantly larger than the ICCs for the Individual items. The results show the importance of how items are worded. If researchers want to accurately examine the between-groups component of the group therapy relationship they should develop measures that ask clients to describe their perceptions of the group, not the members own experience of the group.

Binge eating partially mediates the relationship between body image dissatisfaction and psychological distress in obese treatment seeking individuals

INTRODUCTION

We compared the binge eating pathway linking body image dissatisfaction (BID) and psychological distress of obese adults entering and not entering psychological treatment for their weight problems.

METHOD

90 obese participants seeking an integrated treatment (OB-IT) and 87 obese participants seeking only medical treatment (OB-MT) for their weight problems completed questionnaires on BID, binge eating and psychological well-being.

RESULTS

Only in the OB-IT group, binge eating behaviors mediated the relationship between BID and psychological distress.

CONCLUSIONS

Both BID and binge eating behaviors need to be addressed in the psychological and medical treatment for obesity to enhance psychological well-being.

Are attachment dimensions associated with infertility-related stress in couples undergoing their first IVF treatment? A study on the individual and cross-partner effect

STUDY QUESTION

Are attachment anxiety and avoidance dimensions in female and male partners in couples seeking infertility treatment associated with her and his infertility-related stress?

SUMMARY ANSWER

Attachment dimensions are significantly associated with several aspects of infertility stress in couples undergoing IVF treatment.

WHAT IS KNOWN AND WHAT THIS PAPER ADDS

Attachment dimensions of anxiety and avoidance (where highly anxious individuals fear rejection and are preoccupied with maintaining proximity to their partner and highly avoidant individuals are uncomfortable with intimacy and prefer to maintain distance from their partner) may influence the well being of individuals undergoing IVF/ICSI treatment. This study showed that one partner's attachment dimensions had a direct effect on the infertility-related stress of the other partner.

DESIGN

Cross-sectional study of consecutive couples before starting their first IVF/ICSI treatment in 2009-2011 at the ANDROS clinic in Palermo, Italy.

PARTICIPANTS AND SETTING

Three hundred and fifty-nine couples undergoing fertility treatments were invited to participate in the research. The final sample comprised 316 females and 316 males who filled out the psychological questionnaires (Experiences in Close Relationships; Fertility Problem Inventory; State scale of State-Trait Anxiety Inventory). The participants included patients who had a primary infertility diagnosis and were about to undergo their first IVF or ICSI treatment.

DATA ANALYSIS METHOD

Paired t-tests were used to examine gender differences on the study variables (attachment anxiety, attachment avoidance, infertility stress, state anxiety, etc.). Associations between infertility-related stress and the study variables were explored using hierarchical stepwise multivariate linear regression analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

Attachment anxiety and attachment avoidance were significantly associated with global infertility stress in both women (β = 0.24, P < 0.01 and β = 0.27, P < 0.01) and men (β = 0.23, P < 0.01 and β = 0.37, P < 0.01). Regarding the cross-partner effects, men's infertility stress and relationship concerns were associated with their partners' attachment avoidance (β = 0.10 P < 0.05 and β = 0.12, P < 0.05); and the infertility stress of women and the scores for need of parenthood were associated with their partners' attachment anxiety (β = 0.14 P < 0.05 and β = 0.16, P < 0.05).

BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION

The study data are cross sectional, and specifically focus on associations between adult attachment style and infertility stress. Treating the data from couples as independent observations may be a limitation of the analysis. Potential moderators of such relationships (e.g. coping strategies, stress appraisal) are not included in this study.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study.

Early and later predictors of outcome in brief therapy: the role of real relationship

OBJECTIVES

The study examined whether clients who continued longer in brief therapy reported stronger associations of real relationship and working alliance with therapy outcome than clients who received very brief treatment. It also examined whether real relationship and working alliance assessed early in treatment predicted outcome differently from that assessed later in therapy.

METHOD

Fifty clients (32 women; M(age) = 22.3 years) were recruited from a university counseling center. Thirty-two clients (very brief therapy) completed the post-third session assessment of real relationship and working alliance, and 18 (brief therapy) had both the third and eighth assessment.

RESULTS

The real relationship scores (both client and therapist rating) were significantly correlated with outcome in the 18 brief therapy clients, but not in the 32 very brief therapy clients. We found significant correlations between outcome and Bond element of the working alliance in the 18 brief therapy clients, and between outcome and working alliance-Task in the 32 very brief therapy clients.

CONCLUSIONS

These findings suggested that the strength of the early real relationship, as well as later real relationship, are highly associated with outcome for clients who continue brief therapy past its earliest stages.

The factorial structure of the Outcome Questionnaire-45: a study with an Italian sample

In this article, the authors study the factorial structure of the Italian translation of the Outcome Questionnaire 45 (OQ-45) in a sample of college students (n = 522) and psychiatric outpatients (n = 301). The relative goodness of fit of six competing models of the OQ-45 was examined using confirmatory factor analysis (CFA). Specifically, the study examined the relative fit of the most frequently presented models in the literature and three alternative models. Results of the CFA provided support for the four factor bi-level solution, suggesting that the OQ-45 is a multidimensional instrument that contains one general factor and multiple unique subscale factors.

[The outcome questionnaire 45.2. Italian validation of an instrument for the assessment of psychological treatments]

AIMS

The Outcome Questionnaire (OQ-45.2; Lambert et al., 2004) was designed to measure important areas of functioning (symptoms, interpersonal problems and social role functioning) that are of central interest in mental health. The cross-cultural validity of the OQ-45.2 in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and normative scores of the Italian OQ with the original American version.

METHOD

Data were collected at university (N = 461), in community (N = 61) and in three mental health care organisations (N = 301).

RESULTS

Results showed that the psychometric properties of the Italian OQ were adequate and similar to the original instrument. The CFA supported the multidimentional construct system of the instrument. Furthermore, normative scores were different for the Italian and American samples and this resulted in different cutoff scores for estimating clinically significant change in the Italian population.

CONCLUSIONS

The Italian version of the OQ-45.2 appears promising as a measure of general psychological distress, and it could be used to measure the psychotherapy outcome in routine clinical practice.

Individual and health-related quality of life assessment in amyotrophic lateral sclerosis patients and their caregivers

We performed a cross-sectional study aimed to address the quality of life (QoL) and putative associated variables in amyotrophic lateral sclerosis (ALS) patients and their respective caregivers, using both health-related (WHOQOL-BREF) and individual (SEIQoL-DW) QoL instruments. Further, we sought to investigate concordance within patient-caregiver pairs for ratings of respective QoL. Thirty-seven patient-caregiver pairs were included in the study. QoL was rated low by both patients and caregivers, and there was no significant difference between them on scores of overall QoL, even if caregivers showed higher scores on the physical and psychological WHOQOL-BREF domains compared to patients. No correlation could be found between QoL of both patients and caregivers and all the examined socio-demographic variables. Moreover, concordance between patients and respective caregivers was low for ratings of QoL, suggesting that their QoL is not necessarily interrelated, and that these couples do not actually represent a unique psychological entity. Interestingly, physical dysfunction, measured with the ALS-FRS, was not significantly correlated with caregivers' individual QoL scores. The most frequently nominated SEIQoL-DW cues were related to health (physical and psychological) and family for both patients and caregivers, and there was high agreement for the choice of areas important for subject's QoL. Interestingly, patients and caregivers who endorsed spirituality as a significant domain reported better QoL. Our study confirms that ALS has a negative impact on QoL in both patients and caregivers. However, caregivers who present lower QoL levels are not always those who have to look after the most physically or psychologically impaired patients. Major attention on QoL issues of both patients and caregivers, family status, and health perception, integrated with the medical evaluation, could lead to a better understanding of the problems related to the caregiving experience, and could help couples dealing with this life-threatening disease.